51D2179144 CLIA NUMBER - TRISTATE PAIN CARE

Laboratory Demographics

  • CLIA Code: 51D2179144
  • Facility Name: TRISTATE PAIN CARE
  • Facility Address: 3140 COLLINS FERRY RD
    MORGANTOWN, WV
    ZIP 26505
  • Facility Phone: 304 397-5480
  • Facility Type: Other - PAIN MGT CLINC
  • Facility Type: Waiver
  • Lab Director: SUDHAKAR B. MANNAM
  • NPI Number: 1396267886
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 51D2179144
LAB Type Other - PAIN MGT CLINC
Facility Name TRISTATE PAIN CARE
Street 3140 COLLINS FERRY RD
City MORGANTOWN
State WV
ZIP 26505
Phone 304 397-5480
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/18/2024
Certificate Expiration Date 2/17/2026
Facility Type Other - PAIN MGT CLINC
Lab Director SUDHAKAR B. MANNAM

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This page was last updated on: 9/29/2025